Molecules to Medicine: When Religion Collides with Medical Care: Who Decides What Is Right for You?

The editors of Scientific American regularly encounter perspectives on science and technology that we believe our readers would find thought-provoking, fascinating, debatable and challenging. The guest blog is a forum for such opinions. The views expressed belong to the author and are not necessarily shared by Scientific American.

Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

The recent presidential candidate debates, fights over insurance coverage for contraceptives, and the Virginia and Texas legislatures’ imposition of intrusive, unnecessary ultrasounds prior to any abortions are highlighting the fundamental issue of the role of religion in health care and the separation of Church and State. While the emphasis has been on reproductive care, the imposition of religious beliefs on access to medical care is far more wide reaching in its deleterious effect on the ability of people to choose their care and have their medical needs met.

Since I first started medical school, two principles were inculcated in me as foundations of medicine. First was the importance of searching for—and following—evidence in medicine, and the large human cost of not doing so. Second was our promise to the public, via the Hippocratic oath and centuries of precedent, to put patients’ needs first, above our own. I’ve dedicated my professional life to these tenets.

I hope to share some historical background on the intersection between medical care and religion, and what happens when we deviate from these central tenets of patient-centric care and then, in a subsequent post, tell more about the impacts of religious beliefs on research and public health.

As you read, consider: “When religion collides with your medical care, who should decide what is right for you?”

Background:

Access to health care information, health services and medical research has being limited by two growing trends: the infusion of increasingly restrictive religious doctrines at faith-based health systems and the implementation of ideologically-driven, rather than scientific, evidence-based, public policies.

Many hospitals with religious sponsors (Presbyterian, Methodist, Episcopalian and Jewish) are functionally secular and do not limit patient choices based on theology. In contrast, religious doctrine dictates what services will (or will not) be provided at some Baptist hospitals and all Adventist and Catholic health care institutions (HCIs). Religious restrictions affect not only reproductive care, which has garnered the bulk of attention, but affects access to new technologies, end-of-life care choices, vaccination, risk reduction counseling, and even access to scientific information.

Ideologically driven policies impact our ability to care for our patients using evidence-based medicine and have wide-ranging repercussions. As an Infectious Diseases physician and clinical researcher, I’ll share some of the impacts I have witnessed, including those from the bitter merger between the Catholic hospital and secular hospital in my own rural community. (Disclosure: I opposed the merger, from the heretical belief that health care decisions should be between a patient and his or her physician, and not dictated by anyone else’s religious beliefs.)

Physician and community impact

Picture courtesy MergerWatch Project

On local levels, religiously based restrictions can interfere with access to care and physician privileges, the approval to practice in a specific health care institution. Physicians must apply for and be granted such “privileges” to practice at each hospital. Catholic-affiliated institutions require that any physician requesting privileges agree, in writing, to abide by the Ethical and Religious Directives as a condition of practice; s/he will not be granted privileges, or may have those privileges revoked if s/he violates the ERDs, even in the interest of saving a patient’s life.

Nearly one-third of all Catholic hospitals are located in rural areas. In many cases, the Catholic health system becomes the sole provider of care in a county or entire region. This particularly impacts rural patients, who may be unable to seek health care in larger metropolitan areas, hours away. Depending on the nature of the medical problem, the weather and road conditions, the state of public transportation, and lack of money/support, it is often not practical or feasible for a patient to seek healthcare elsewhere.

In general, stricter interpretations of religious doctrine are being applied to a variety of issues. The general public and health care consumers are often unaware of these restrictions until confronted with a problem, as negotiations are often conducted behind closed doors. This was true in my own community, where all negotiating parties—even the mayor—were under a gag order not to reveal details of a proposed merger.

Following are some of the less publicized aspects of the impact of religion on access to health care.

Last summer, the Institute of Medicine recommended that women receive full coverage of contraceptives as part of essential preventive care for them, stating, “To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the U.S. in 2001, the report urges that HHS consider adding the full range of Food and Drug Administration-approved contraceptive methods as well as patient education and counseling for all women with reproductive capacity.

Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.”

Similarly, some state legislatures have become more conservative, eroding what have been broad standards of medical care and patients’ rights to access to care. One suchstates’ rights trend also uses so-called “conscience clauses,” which are being used not only to exempt individuals from participating in acts that they personally find morally objectionable, but increasingly to allow organizations, including hospitals and insurers, to exempt themselves from providing services, counseling, or referral.

For example, legislation passed in Mississippi gives health providers, institutions, payers, and potential employees the absolute right to refuse to participate in (including providing services, counseling, or referring patients for) any health service to which they have a moral objection. There are no exceptions to protect a patient’s health or life.

At Louisiana State University Medical Center, a young woman with cardiomyopathy was denied a medically necessary abortion, forcing her to be transferred to Texas to save her life. And in 2010, in Phoenix, Sr. Margaret McBride was excommunicated for allowing an abortion to save the life of a critically ill 27-year old mother of four. There is a pattern of religious mandates that endanger a woman’s life by requiring that “physicians act contrary to the current standard of care.”

Arizona’s Senate has just passed a bill that shields physicians from litigation for failing to inform pregnant women of prenatal problems or lying to their patients if the truth could lead to the decision to seek an abortion. Texas has just sacrificed cancer screening and preventive care for poor women because some of those funds go to Planned Parenthood—even though the funds are not used for abortion. This is guilt by association, as the law will cut off clinics with any affiliation to a provider, no matter how tangential.

Similar bills are pending in several other states and in Congress. The American Bar Association responded, passing a resolution opposing “governmental actions and policies that interfere with patients’ abilities to receive from their healthcare providers … all of the relevant and medically accurate information necessary for fully informed healthcare decision making. . .as defined by the applicable medical standard of care, whether or not the provider chooses to offer such care.”

Although they may be cloaked innocently, as “conscience” clauses, this belies their nature. They are, instead, unconscionable clauses, allowing health care workers to shirk the professional responsibility to put their patients first. Refusal clauses deny our patients the care that they need. They should be publicly identified and bluntly referred to as such—a refusal to provide care.

End of Life issues

Religious restrictions affect far more than contraception and abortion.

Many organizations have appealed to the JCAHO to require health care entities that have institutional ethical or religious restrictions concerning certain health care services and information to provide explicit and timely written notice of those restrictions to prospective patients and staff. (After the merger in our community, services were shifted between the secular and Catholic hospitals.

My elderly mother had to be hospitalized at the Catholic hospital to receive necessary services (or travel a considerable distance). No one in registration, admitting, the operating room, or her floor could tell us what the policy “Living wills will be honored if not in conflict with hospital policy” meant, adding considerable needless stress to an already difficult situation. This was also in violation of the Patient Self-Determination Act (PSDA), which requires institutions receiving Medicare or Medicaid funding to provide notification as to whether a patient’s Advanced Directive will be honored.

If religious organizations want to impose their beliefs on others who do not share them, should they be receiving public monies—our monies—to deny care that we need and deserve? Should their “conscience” trump yours? Who should decide what care is right for you?

——————————-

Footnote: *The figure is likely to be higher as this analysis only included systems that were readily identified as being Catholic. It does not, for example, included merged institutions that may have agreed to abide by the Catholic ERDs.

About the Author:Judy Stone, MD is an infectious disease specialist, experienced in conducting clinical research. She is the author of Conducting Clinical Research, the essential guide to the topic. She survived 25 years in solo practice in rural Cumberland, Maryland, and is now broadening her horizons. She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up, she has become especially interested in neglected tropical diseases. When not slaving over hot patients, she can be found playing with photography, friends’ dogs, or in her garden. Follow on Twitter @drjudystone or on her website. Follow on Twitter @drjudystone.

38 Comments

For any hospital that refuses legal procedures, all federal support should be withheld. The United States cannot allow the Roman Catholic Church or any other religious group to determine the medical policies of hospitals. Doctors, not bishops, should determine medical procedures.

I do believe the Hospitals are obligated, by law, to take Medicare/Medicaid patients with a funding caveat. If you refuse funding where does that leave patients? You as a doctor I’m sure expect to be paid. Or will you provide free care to prove your belief?

Interesting article, but I feel there is a false presumption that decisions based on scientific, evidence-based policies are morally neutral and not influenced by any ideology. Despite what Judy Stone asserts, the identification of widespread access to abortion can be traced back to an ideology which views a woman’s rights as being in opposition to the rights of her child. During her training, Dr. Stone was taught to put the rights of her patient above her own personal feelings or opinions. She is dedicated to the care of her patients, but I believe that the Hippocratic Oath extends to all patients. I’m posting from Ireland where we have an excellent record in pre-natal care. Our doctors do their utmost to care for both their patients-mother and baby. The absence of abortion has not affected the standard of care. If anything, seeing abortion as a ready option might actually compromise a doctor’s duty to do all in his or her power to assist his patients and offer them the best treatment options.

Dr. Stone makes her feelings clear when she speaks of women having to go through ” intrusive, unnecessary ultrasounds” before having an abortion. This is a personal view and is not a morally neutral statement, nor is her opinion based on any scientific certainties. She sees no value in something which may educate women on the reality of their situation and sees it as a tiresome imposition.

There has always been a right to make a conscientious objection to being involved in anything which goes against one’s moral standards. Judy Stone is obviously irked by the fact that Catholic hospitals maintain their moral standards, while she wants her ideology to become the accepted norm. I maintain that patients have a right to be secure in the knowledge that their particular doctor really does honor the Hippocratic Oath in respecting the dignity of all human life. Catholics and those of other faiths are also tax payers. Why should their views be undermined and sacrificed on the new altar of secularism? And, why are these far-from-neutral opinions being painted as being in the best interests of patients and, particularly, women?

As for the case of abortion, ectopic pregnancies at the moment have no way to be resolved that would save both the mother and the baby. At this time, 2 out of 100 pregnancies are ectopic and banning abortion would result in the deaths of 40 000 women every year in the US alone.

@Maria B, so you are okay with religion deciding what others should do in their personal lives? Are you willing to adopt children who are born out of unwanted pregnancies? What if you had a child and any suffering in their life was caught on video and you were forced to watch it over and over, reliving terrible memories? Sounds ridiculous right? Well so does forcing people to have unnecessary ultrasounds before an abortion.

What if Muslims wanted to force their religions beliefs on you? Would you like being forced to marry and bed with a man when you are still a child? How about not being allowed to drive, or having to cover up your entire body?

Or how about something about women from the bible? “A woman should learn in quietness and full submission. 12 I do not permit a woman to teach or to assume authority over a man; she must be quiet.” 1 Timothy 2:11-12.

I hope you aren’t in a position of authority over any man. That is a no no. I also hope you didn’t say a word in church… “Let your women keep silence in the churches: for it is not permitted unto them to speak; but they are commanded to be under obedience, as also saith the law. And if they will learn any thing, let them ask their husbands at home: for it is a shame for women to speak in the church” 1 Corinthians 14:15-35

Ridiculous right? Where do we draw the line with how much religion can enforce its own laws on others?

EXCELLENT article!
Like the significant breaches in the Constitutional Wall of Separation that our Founders considered absolutely fundamental to this Republic… the intrusion of religious doctrine into the field of medicine is both unethical and dangerous.

As a practicing physician, i have experienced this burdensome intrusion first hand… both as fall-out from a near-by Catholic institution and at a Baptist affiliated hospital. What is really frustrating is that there is no reasoning with the administration or their lackey “care committees” who tow the corporate-religious line.

I personally had a patient admitted to a rural Virginia hospital with a tubal ectopic, who’s medical therapy (methotrexate) was delayed because the culture there gave primacy to the nurses’ twisted “christian” beliefs (they would be “killing a baby”)… versus the very real risk of tubal rupture and abdominal hemorrhage to the pregnant woman. Incredibly, it was the day after admission when she finally received the ordered Rx, and the nurse who administered it garnered the nickname of “angel of death”.

Anyway… that this sort of Theater of the Absurd in Hospitals continues in the 21st century is a sad commentary indeed and needs to be brought to light.

Finally, if prayer actually worked… and if there actually was a beneficent sky-god… or “guardian angels”… um… i don’t think we’d need the myriad hospitals, clinics, doctors offices, pharmaceuticals and medical/surgical procedures… and the history of our species would be far different indeed. It’s long past time to jettison the Myth.

Religion can and should be able to enforce it’s laws/canon within it’s walls…It is when they breach those walls that problems arise. Also there is a misconception in this country that our version of Catholosism is common or accepted everywhere. It is not. You can not pick and choose which canons you follow. You have no right to call yourself a Catholic (muslim, Baptist, etc…) if you do ot follow it’s rules…No 1 person or group of persons can decide what a religion can and cannot allow.

Don’t get me wrong. I don’t think religions have any business being in any business other than religion. I do truly believe you cannot call yourself a _____(insert religion) if you intentionaly choose to disobey the canons…

The truly faithful are very dangerous because (sorry) they act in unpredictable ways and put stupidity ahead of logic, commonsense, and provable facts.
We have to remove them from places where they can harm other people. They are all most likely, different levels of psychopaths.

No religion is actively banning anything, just because in the western world no religion has policemen, judges, jails and penalties for those who don’t follow their instructions, either they say the sinner: You’re in a wrong way, or as much they say: You’re out of a full participation in the church. The strenght of this instructions depends solely in the degree the believers endorse it, human acts in the absence of freedom have no moral value, and one never knows the imputability of some acts, as the degree of freedom of the one who makes it is unknown to everybody. When applied, punishments have only a value of deterring others to repeat a wrong action, one can judge actions, but can’t judge those who do it, judging people is God’s task, and judgements will not take place until the last day. It’s impossible for anybody actually banning some approaches to family planning, even if somebody wanted to, nobody’s trying this currently, with the exception of non-medicated IUD’s, purely abortive, that were forbidden in some countries long ago; all means of family planning have medical indications out of family planning, but abortion is a different thing, as there’s a third party that is a victim, the unborn. Currently, more than 50% of abortions are done outside medically ruled facilities, and one may think that elimination of punitions for those who commit an abortion has just increased its number, 5 millions in GB since the current policy started, but hasn’t increased the safety for women. I’m not aware of data about complications and fatalities in non-medical abortions, in a western medicine environment, but some say any pregnancy is more risky than a medically made abortion. It’s the women’s choice, as nobody is in the condition of effectively blocking abortions, to consider the ethical issues, and the consequences of her acts, balancing pros and cons. The risks for a pregnant woman has been made nearly negligible with the advances of medicine, and eugenic abortions sound worse than nazi to me. Sincerely, I can’t find any serious pro. Salut +

Doctors and science can find several ways out. I have an interesting story to tell. Some years back when a child was brought to India from a West Asian country for an operation, her parents’ religious beliefs didn’t allow the doctors to transfuse “others” blood into her body. Her condition was very weak. So the doctors here found a way out – by boosting her own blood levels for several months by carefully giving all the vital nutrients required and monitoring, collecting and storing her own blood and then giving it back to her at the time of operation. In the end the child was saved.
Saving the lives and helping the needy are the main priorities. Science can find ways to do this – religion or no religion!

I am embarrassed by the medical community’s participation in abortion debates. Not only society, but we as scientists are letting our feelings of what “should be” influence our scientific judgment of what “scientific fact” is. We argue that religious people do this erroneously, but we are ourselves doing the same thing.

The degree to which definitions are used incorrectly, the degree to which emotional feelings twist logic, and the degree to which facts are simply ignored in order to feel better are truly unbelievable. We easily fall into the trap of rejecting facts because we do not want to believe them, but fact is fact, independent of whether or not it is inconvenient and uncomfortable.

Debates regarding abortion need to become scientific. Definitions need to be used correctly. Emotional trigger words need to be eliminated.
We must be honest, accept facts, and just call it what it is. Only then can a rational discussion occur.

Fact: “Human” defines our species. An individual human organism has a life cycle, as does any life form.
Science uses terms to denote the phase of life development: Zygote, Morula/Blastocyst, Embryo, Fetus, Neonate/Infant, Child, Adolescent, Adult, Elder/Geriatric. However, these are general labels given to approximate phases, and most are behavioral markers rather than biological changes.

Development is a line. Like a line, no matter how far you zoom in, you can never see breaks in between individual points – zoom in to the cells dividing, genes transcribing, genetic signals switching, molecules moving, and between 10,000,000 to 10,000,000,000 chemical reactions per cell per second, with the shift of electrons moving at near the speed of light – there is no abrupt change in the human organism’s biological development. Changes are gradual in development; it is constant and fluid from zygote to death.

Fact: At no point in the life cycle of a human organism does it share even one single cell with the mother.
By definition, a zygote/embryo/fetus is an individual human organism.

To stop the life process of any organism is to kill it.
Abortion is to stop the life process of a human organism.
Therefore, abortion is killing a human organism.
To support abortion, a person MUST be able say that they support the killing of human organisms.

Otherwise, they are either deluding themselves to feel better, or simply lying.
Any rationalization for abortion is irrelevant to this fact.

Therefore we have to open the door to the grizzly discussion: when is killing a human considered acceptable?

By basing decisions on feelings and defending it by stating it is legal, we are currently just like the doctors in Nazi Germany, determining what qualifies a human life deserving killing – instead of based upon the human’s race and religion, in this case it is the human’s age.
But this judgment only applies to age prior to exiting the vagina (or uterus via cesarean) – because after that, it’s considered unconscionable to kill a human.
The concept of infanticide horrifies us as doctors; however, 5 minutes earlier when inside of the vagina, the now-infant was then a fetus. The concept of feticide placates our desire to “respect” a woman’s reproductive control. How scientific is this?

If we continue to ignore fact to feel better about supporting abortion, we are lying to ourselves, to our patients, and to the society that looks to us for expert opinion.

The whole original post is not “scientific”, but rather based on what can be called “pseudo-science”.

If it is truth we are trying to present, then we definitely need to stick to the scientific “facts”, as MD perspectives has pointed out.

Judy’s article is based on her opinions, and has very strong atheistic undertones.

She is expressing her own opinions only. This is NOT science.

As her biography states “She particularly loves writing about ethical issues, and tilting at windmills in her advocacy for social justice. As part of her overall desire to save the world when she grows up”…

She is attempting to write about an ethical issue here, not science – is that suitable for this particular website??

She may wish to “save the world when she grows up”, but as the saying goes, “the road to hell is paved with good intentions”.

Many big personalities have had their own ideas of how to save the world in the past, by various means including genocide, murder, etc, but time has shown that they were wrong.

Killing the child in the womb is murder, now matter what your law or ethics of life say!

That is science…

You can try to justify it in whatever way you like, but killing the innocent is plain and simple murder. Your “GOOD intentions” are just that, “your GOOD intentions”, nothing more or less.

You cannot create life, therefore you cannot take it.

Modern science, correctely termed “mechanistic science” is NOT sufficient in itself to make any ethical judgement calls, as ethics and morals are in the realm of philosophy.

Although this world is rampant with all kinds of murderous rascals doing whatever they like, backed by their mechanistic world view, they are NOT truly scientific.

The phrase “science” is being prostituted by tons of self-made pop philosophers all over the world today…

Science has always been the search for truth, meaning that it must include ALL aspects of our reality, otherwise it is simply “technology”, not “science”.

Even medicine, without consideration of the higher realities that are not understandable by mechasistic scientists, is no more than the attempt to prolong one living entities struggle to enjoy his/her gross senses. Not a very praiseworthy goal.

To truly be SCIENTIFIC, we need to include the NON-MECHANISTIC side of reality. That is the part that can not be reduced to numbers or formulae.

Mechanistic (or normal) science has no instruments to study the fundamental principle of our lives, the one fact that none of us can deny, that we are conscious.

The study of consciousness is vital in the search for truth (science), because it is the most prominent feature of our existence. Without it, there is NO science, simply because there would be NO scientist.

So understanding consciousness is the first step in science, everything else falls into one or more of the other categories:

1. speculation
2. fanaticism
3. sentimentalism

All of the greatest “fathers” of modern science, physics and quantum theory (real scientists – not your typical journalist) agree that they have no ability to understand consciousness. They can not account for the observer, that is, themselves. There are numerous citations of this fact.

Real science actually means to understand consciousness as well as gross matter, for without that we are just speculating again, without knowing all the factors involved (truth).

But how will you do it?

This is where you need a different approach.

The main tool required is “humility”, it is a vital component, and you can make NO progress without it.

The first step is to have the humility to admit that you do not know everything, and that there may be parts of reality that you can only access with your consciousness.

You must accept that there MAY be parts of reality which are out of your control, and not even be understandable by you YET.

If you discount a higher reality (including the possibility of a higher power like a God), and at the same time try to understand consciousness, you WILL fail because of your unreasonable doubting (blind doubt).

Dr. Stone, you summarized the current situation best when you penned: “a pattern of religious mandates that endanger a woman’s life by requiring that physicians act contrary to the current standard of care.” Indeed. Practicing evidence-based medicine requires that at a minimum. For any medical institution that accepts public funds, we should demand that. I feel sorry for women of Catholic faith who must accept a lower standard out of submission to their religon. What a lousy deal. So much for benevolence.

One must be careful with the words: abortion is a woman’s choice, but should never be a woman’s right. As the insurers who pay, for example, family planning pills for women have not the right of knowing if the prescription is for family planning or for a medical indication, neither insurers nor pharmacists have a right to refuse paying or dispatching these drugs, if they do subsidize other drugs. Day-after drugs and similar products are a fully different subject, as it have just one indication, and people has the right to morally disagree with it. For the rest, the doctor writes a prescription, the person goes to the pharmacy office or shop to get the drug, and that’s all. Salut +

Respect and confidence are casualties when patients are unsure of the underlying alliances of the healthcare providers are suspect. Who or what interests besides those of the patient are being served when treatment or advice is delivered? Is it the ideology of the hospital or clinic,interests subsidized by a drug or insurance company or sound medical consideration that determines the patient’s medical treatment?

Judy Stone, and SciAm Editors:
It’s very simple to disprove most of the “Big Lies” in this clearly anti-Catholic propaganda. The most obvious rebuttal, clear to any rational reader, is based on your statement that “In twenty-two states, Catholic hospitals account for 20-30+% of admissions.” The smart reader will realize that Catholics care enough about people to build hospitals where others refuse to build them. Imagine what health care would be like in those regions if Catholics had not sacrificed to build those hospitals.

This biased rant is filled with partial facts like: “religious health systems received more than $45 billion in public, taxpayer-supported, funds”. Any scientifically-minded reader will realize that it is the patients who receives the support from the funds! Taking away public funding implies that patients would have to cover the entire bill unless they go to a secular hospital. Now that would be forcing secular beliefs on patients!

In fact, your biggest lie is the claim that any beliefs are imposed on patients. You claim to know all about Catholic beliefs, yet you call foul when those who are caring for your mother will not take precious time to explain to you the details of Living wills that conflict with hospital policy. I believe that this fits the definition of Chutzpah!

On the contrary, YOU attempt to impose YOUR beliefs on the readers by hiding the full story. But most of all, shame on Scientific American for giving you this science platform to present a “distort-the-facts” rant against Catholic hospitals. It’s clear that some influential people at SciAm are trying to impose their humanist/atheist beliefs on the readers.

Excellent article, as usual. Thank you Dr. Stone. The number of confused and misguided comments should alert us all to what a serious problem this is, not just among church bureaucrats and politicians, but among the lay public who have very little understanding of science and even less of the fundamental importance of the separation of church and state, at least in the USA.

@MariaB: It is your personal opinion that abortion is morally wrong. This is a perfectly acceptable opinion to have, as long as you understand that hospital policy should not be determined by your or your church’s opinion. What’s more, in the US we have a very important defining characteristic: church and state are separate entities and neither is supposed to have any power over determining the policies of the other. If the federal government is footing any part of the bill in a religiously affiliated hospital, then that hospital must follow the guidelines set by the non-religious medical establishment (which is based on science…perhaps you have noticed that there is no “revelation” for penicillin in the bible, despite the abundance of plagues).

@#13: Not only have you missed the point of this essay entirely, you have been misinformed on the difference between science and pseudo-science.

It is important to understand that Dr. Stone is advocating for *everybody’s* right to self-determination. No one will force you to have an abortion if you believe that abortion is wrong. In fact, hundreds of thousands of people are going to die without organ transplants. Do you think you should be forced to give one of your kidneys or one of your lungs to save another’s life? How many of you have done so? Being “pro-life” has it’s limits, honestly speaking, doesn’t it? Have you ever gone to confession and cried over picking up an acorn and tossing it in the street? How many potential grand oak trees have you “killed?” And please somebody give me a rational objection to the use of the Plan B pill, which does not ‘destroy’ a pregnancy. In fact, after taking a Plan B pill (assuming it is administered correctly and in a timely manner), there is no pregnancy. SPERM WILL NEVER MEET EGG. THERE IS NO POTENTIAL PERSON. Because this pill stops ovulation. You don’t have to take a Plan B, have an abortion or take birth control pills. What gives you the right to say that everybody should do what you are doing?

Dr. Stone is not trying to take away any of your personal decision making powers. In fact, she is advocating for every person and her physician to collaborate and be able to determine the best treatment plan for the individual patient. As for requiring trans-vaginal ultrasounds before a woman has an abortion, unless the patient wants this procedure, legally this is an assault on the patient, which is illegal, just as forcing any medical procedure on a patient is. It is also a tremendous waste of resources during a time when this country is trying hard to prevent unnecessary, costly procedures. Honestly, it is not a stretch to call this a form of rape.

1. I disagree with the trans-vaginal method of ultrasound. Although currently it provides the best resolution, I would prefer it be done trans-abdominally.

However, I absolutely believe that any person should make a medical decision based upon all available facts – and this is even more so for an ethical decision.
One of those facts is the reality that there is a human organism living inside of their body, the life of which they are deciding to end. We are responsible for decisions in our life, and doing such a life-altering procedure is not something that should be done in ignorance of facts.
Also do note, in surgical abortion, it is done by using blades to scrape the embryo out from the walls of the uterus through instruments inserted vaginally, using suction vacuum tubes inserted vaginally.

2. Plan B only works to prevent fertilization if the ovum has not yet been released from the ovary. Sperm travel 3mm/min and reach the fallopian tubes within 30-60 minutes. Sperm can remain viable for up to 5-6 days. If you take the levonorgestrel pill anytime after ovulation, it is primarily an abortive, by mechanism of preventing implantation in the uterus of the living embryo.
If the embryo isn’t able to implant in the uterus, that human organism will die in the uterine secretions as they exit the body.

A few of many references:
PubMed
TIMechanism of action of emergency contraception.
AUGemzell-Danielsson K
SOContraception. 2010;82(5):404.

A major barrier to the widespread acceptability and use of emergency contraception (EC) are concerns regarding the mechanisms of action of EC methods. Today, levonorgestrel (LNG) in a single dose of 1.5 mg taken within 120 h of an unprotected intercourse is the most widely used EC method worldwide. It has been demonstrated that LNG-EC acts through an effect on follicular development to delay or inhibit ovulation but ***has no effect once luteinizing hormone has started to increase. *** Thereafter, LNG-EC cannot prevent ovulation and it does not prevent fertilization or affect the human fallopian tube. LNG-EC has no effect on endometrial development or function. In an in vitro model, it was demonstrated that LNG did not interfere with blastocyst function or implantation.
ADDepartment of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, S-171 76 Stockholm, Sweden. kristina.gemzell@ki.se

UpToDate:
Mechanism of Action Pregnancy may be prevented through several mechanisms: Thickening of cervical mucus, which inhibits sperm passage through the uterus and sperm survival; inhibition of ovulation, from a negative feedback mechanism on the hypothalamus, leading to reduced secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH); and inhibition of implantation. Levonorgestrel is not effective once the implantation process has begun.

@aidel – you say: “you have been misinformed on the difference between science and pseudo-science.” – can you explain your opinion or objection clearly?

Also, I believe you have missed the REAL point yourself!

Your problems with abortion have come about by your inability to control your genitals. If you don’t want children, don’t engage in sexual activity. If you do engage, then take the responsibility of raising a child. Don’t try to get the enjoyment without the responsibility, that is not the natural way. Again the pseudo scientists try to dominate and exploit nature for their own purposes, only to increase their problems. That is just foolishness. Your so-called science has not solved the real problem – “you will die”…
Try not to knock my previous comments on science just because you cannot understand them. You have a lot to learn on the path to giving up your shallow ignorant nature.

I don’t understand Mrs Stone problem. Free choice exists between religious and other hospitals. The problem might be conceivably lack of other hospitals around, which Mrs Stone doesn’t suggest.

Since many Americans are Catholics, no wonder they choose Catholic hospitals. Since Catholic hospitals admit only 30% of patients, by Mrs Stone own words, there is ample choice. It is Mrs Stone who wants to forcibly deny them a choice.

If Catholic hospitals are somehow of higher standard and preferable to non-catholics, then the correct question is perhaps what is terribly wrong with atheists and others attitude to medical care?

I don’t wish Mrs Stone to experience living in eg. the atheist Netherlands where euthanasia is legal and common and one type of morality – atheist – is enforced. As the result, some elderly people see emigration from Netherlands as the only way to ensure they will not be quietly euthanized.

With all due respect to the religious sensibilities of the non-scientists here (I include MD perspectives in that category), if you want to run your own life according to Bronze Age superstitious religious principles, go right ahead, but don’t impose those superstitious religious principles on the rest of us. When medical professionals defer to the superstitious beliefs of non-medical professionals, the result is malpractice.

In the case of ectopic pregnancies, the Catholic treatment is to remove the fallopian tube which contains the fetus. A more costly, invasive, dangerous treatment with more side effects than simply removing the fetus (which is not allowed). The standard of care for ectopic pregnancy is removing the fetus with the least invasive technique. The Catholic method is malpractice. If you are unwilling to practice medicine according to the Standard of Care, then you should not practice medicine because you are not, you are practicing quackery.

Medical and legal professionals accept the definition of death as being brain death. If a mass of living human tissue does not contain a living human brain, then by definition it is not a human person.

The idea that a fertilized egg that has not yet implanted is a human person is superstitious nonsense.

With zero neurons, that fertilized egg doesn’t have a nervous system and so doesn’t have a brain. If we try to apply the brain death legal standard, we find that in the absence of a brain there is also an absence of a person, and so there is no person that could be alive.

Jerzy New, you might want to check the “information” you get from lying politicians who have religious, political, misogynist and anti-science agendas.

The Catholic Church position is not “pro-life”. It is anti-woman. The recent case where a woman would have died due to pulmonary hypertension is a case in point. Rather than save the woman’s life with an abortion, the Catholic Church explicitly states that it would be better for both to die than for one to survive.

@daedalus2u
You don’t answer my main question – if Catholic hospitals are so anti-woman (put your favorite string of abuse there) and other ones better, why Americans want to be treated in Catholic hospitals? Everybody is free to visit his/her hospital of choice.

About euthanasia of patients in Netherlands – I read nothing from American politicians (put again your abuse here if you think it makes for lack of arguments), I read from patients in Netherlands themselves.

Jerzy, because some people don’t have a choice, and they are lied to about what type of medical care they will be given. When hospitals were taken over by Catholic organizations, people were told there will be no change in medical care. That is a flat out lie.

When people go to an accredited hospital, they believe that they will get “standard of care” treatment. If that hospital is affiliated with a Catholic Organization, and you are a woman, that is simply not the case.

@daedalus2u You said “The idea that a fertilized egg that has not yet implanted is a human person is superstitious nonsense.”

DNA is used by courts for the identification of a unique individual human being. A fertilized human egg has a full complement of DNA, thus defining the unique individual at the moment of conception.

All “superstitious nonsense” aside, scientifically and legally, this DNA argument is the only precise definition of a person in scientific terms. All of the arguments about brain development are imprecise political jargon, which simply provides smoke for justifying unnatural selection.

sunspot, That word you are using, scientific, it does not mean what you think it means.

I understand what the religious apologists are doing, they are misrepresenting the science so as to support their misogynist social power system that keeps them at the top and which subjugates women. A definition of person hood based on DNA is not supportable scientifically or legally.

Legally, death is defined by brain death. A living mass of human tissue that does not contain a living brain is not a living person. That is why organs can be transplanted and the identity of the resulting mosaic body is determined by the brain, not the genome(s) of the component parts. What number of brain cells it takes to constitute a living human brain vs a dead human brain can be a difficult question. If the number is zero, then the answer is easy, it is not a living human brain.

Every cell in a person’s body has the same DNA. Is every cell in a person’s body the same as a person? If a human is cloned, when does it become a new person? When it has the whole unique compliment of DNA? That would be while it is still a somatic cell.

According to this logic, allowing human cells to die instead of using them to generate clones is murder just as much as not allowing a fertilized egg to implant is murder. How many somatic cells are you willing to murder by not allowing them to be grown into clones?

Are monozygous twins two people? Or one person? They have the same DNA, so according to your “definition” they must be the same person? Why do MZ twins get two votes? Why are they considered separate persons? Why doesn’t the argument that they are one person excuse the murder of one of them?

Two fertilized eggs can combine and form a mosaic individual, an individual that does not have a single genome. Is that one person or two? If it is one, which one of the fertilized eggs “died”? Both are still represented in the final adult body. If it is two people, do they get two votes?

If you don’t like abortion, don’t have one. If you don’t like contraception, don’t use it. No one is trying to compel anyone to have and use these things if they don’t want them.

@daedalus2u You said “If you don’t like abortion, don’t have one.”
You are making assumptions that were not included in my comment. I limited my comment to your reference to “superstitious nonsense”, and I refuted that remark with the DNA argument. This is a legal argument (not religious) between one definition of life (brain activity), and the legal acceptance of DNA as uniquely identifying a human individual, whether alive or dead.

As a scientist, I avoid religious arguments; I wish that SciAm editors would do the same. But when I encounter scientists or doctors making illogical, political arguments in the name of science, I am skeptical, and I use a rigorous BS meter. If it sounds like I am defending religion, so be it, as long as the defense is rational. The DNA argument is a rational definition of a unique individual. When does that individual possess rights? That’s a political and religious question, not a scientific question.

sunspot, the uniqueness of the DNA in a tissue compartment has nothing to do with whether the tissue containing that DNA is a living person or not a living person.

Pretending that it does is disingenuous and does not inform the discussion. It clouds the discussion by raising issues that are extraneous. Arguing from DNA as to when person hood starts is not a rational or skeptical argument, it is begging the question.

As I pointed out, no one would use the fact that MZ twins have identical DNA to say they are a single person and so killing one of the bodies isn’t killing a person.

A mosaic individual is not two people.

There is nothing magical about unique DNA that confers person hood. There is no legal standard that uses DNA to define what is a person. DNA is very useful in providing data to indicate if a tissue sample came from one person or another, but there is nothing about DNA that defines person hood. Claiming that DNA confers unique person hood from a “scientific” viewpoint is dishonest.

Religious dogma posits that there is an immaterial mind, aka a “soul”, that is immortal and survives death and is responsible for all human mental activity. There is no evidence for such a thing, and much evidence that no such thing does exist or even could exist, or could have any influence on reality if it did exist. Any belief in an immaterial soul is a religious belief, one held in the absence of evidence.

Religious leaders decided that human person hood begins at conception and then erroneously claim it is a belief based on science.

@daedalus2u
My point, as it relates to the topic of this article by Judy Stone, is that commenters should not assume that the defense of, or refutation of an argument does not always imply irrational “superstitous nonsense”.

For example, the readers of our comments had to think, point by point, about our DNA vs Brain death arguments, rather than dismissing them as soon as they picked up some religious or anti-religious overtones. This is the kind of skeptical reading that I would like SciAm editors to promote. Instead, the unbalanced treatment in the article above immediately polarized readers into two camps, rather than giving a balanced report with both sides of the many issues that she raised.

Granted, blog writing is not professional journalism. For this very reason, SciAm blog editors must carefully stick to non-inflammatory reports, so that the scientific nature of the host site, Scientific American, does not degrade into a very unscientific shouting match. It should be a requirement that any post gives strictly the scientific facts and logical arguments derived from those facts, in a balanced manner.

PS. There are rational arguments, not just religious dogma, that the courts have to consider when deciding the transition point between individual human cells and human personhood (meaning the aquisition of “certain inalienable rights, that among these are life liberty and the pursuit of happiness”, as Thomas Jefferson put it.). The MZ twins need not be a sticking point to the use of DNA as the beginning of human life, since it is the development after conception that determines the differences between MZ twins, and there are numerous, easily defined differences even between MZ twins.

Sunspot, fingerprints are pretty unique too. Before DNA testing, that was how people were identified. When fingerprinting was the legal technique for identifying someone, did that mean that “life” started when the fetus had fingerprints?

Sometimes dental records are used to identify people. Does that mean that “life” starts when the fetus has teeth?

Sometimes scars are used to identify people. There is a specific time in utero when a fetus can produce scar tissue. Before that time, all wounds heal with no scars. Does that mean that “life” starts when a fetus can produce scar tissue?

Uniqueness of DNA has nothing to do with whether a person is alive or has experienced brain death. A person’s DNA does not change when they die, neither do finger prints, teeth, or scars. The presence of a living brain has everything to do with whether a person is alive or has experienced brain death.

People might argue as to whether those are “rational” arguments. I consider them to be disingenuous, just as the DNA argument is disingenuous. If you are motivated to move when “life” starts to as early a time as possible for what ever reasons, then the DNA argument “works”. But it is still motivated and disingenuous reasoning. If the motivation to do so is religious, then it is religious reasoning and not rational reasoning.

If we want to use only unmotivated reasoning, then the question is what is the motivation for even considering the question, and who is or should be motivated to consider the question? The person with the most stake in the question is the woman who owns the uterus that these things are transpiring inside of. Why don’t we let her decide?

Unfortunately, all you socalled professional doctors, scientists, psychos, etc… are outside your depth when you start to dabble in the field of theology.

You may have studied a few books in college, and heard from a few of your big shot atheistic leaders, but you are just an individual human, like the rest of us at the end of the day.

You are not an authority on any of these subjects, just normal people, nothing grand or special.

If you want to talk about life and God, first bring some true scientific (practical experimental) evidence on the most real factor in our lives – consciousness.

Describe it, and it cause. Demonstrate your theories of life and evolution. Otherwise, it’s time for you to just be quiet, and stop pushing your atheistic foolish theories, which are nothing more than that.

All that your childish theories and “smoke and mirrors” philosophies show us, is that you are afraid of a reality that is too big for you, too powerful, and beyond your comprehension.

You are just a bunch of small people, individuals, alone in this vast expanse of time, flapping around for a little while, trying to make sense of it all, but failing miserably, and creating nothing of any value, just more crazy talk, and killing time until time kills you. Grow up!

A prerequisite for popedom should be caring for 12 young children, two of which need to be infants, to include changing diapers, preparing breakfast and dinner, cleaning the residence, washing and ironing clothes etc. while working a full time job on a limited income i.e. $20,000 per year for a minimum of 5 years. The current Pope Francis could handle this, but I doubt many others could. Of course there would need to be strict supervision here to assure that the children would not be abused sexually and otherwise. To do less would be negligence. Based on it’s distant past and current history, the Catholic Church should be placed on every city’s sex offender registry and its religious teaching staff investigated regularly.

I’ve avoided Catholic hospitals for any treatment thus far. I live in a city that has only one hospital and it’s Catholic. I must admit, it’s track record and reputation are quite good but the secular hospital across the river is better. Our city’s emergency rescue will only drive a person to our city’s Catholic hospital, not thru a tunnel to an adjacent city’s hospital. This blog entry has given me the hutzpah to approach city council and get this policy changed. I believe it impinges on my Constitutional and Civil Rights related to religion and creed. Forcing a person to utilize a specific religious organization, by providing city-supported emergency services exclusively to a religious hospital, should be deemed unconstitutional. I would like to see not only a woman’s right to choose maintained but a citizen’s right to choose tax payer funded passage between a religious and secular hospital supported.